Many radiation oncology patients receive insufficient pain management therapy

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Pain is one of the most common symptoms of radiation oncology patients, yet many of them do not receive adequate therapy for the pain caused by their disease or treatments, according to a study in the Sept. 1 issue of the International Journal of Radiation* Oncology*Biology*Physics.

For cancer patients, the researchers said that pain can come from the cancer itself, chronic inflammatory changes, or infections. Standard cancer treatments, such as surgery, chemotherapy and radiotherapy can also cause pain, but despite its common occurrence, pain is a frequent source of patient anxiety due to improper management.

Claude Simone, MD, and colleagues from the University of Pennsylvania department of radiation oncology in Philadelphia and the radiation oncology branch of the National Cancer Institute in Bethesda, Md., sought to determine the main reasons that patients fail to receive optimal pain therapy.

Between November 2005 and April 2006, 106 radiation therapy patients responded to an internet-based questionnaire that evaluated their medication use, pain control and attitudes toward pain medication, including prescription and over-the-counter pain medications.

The investigators found that 58 percent reported pain from their cancer treatment and 46 percent of patients reported pain directly from their cancer, yet 80 percent of those patients said that they did not use medication to manage their pain.

Most patients (80 percent) said the main reason they did not take pain medication was because their healthcare provider did not recommend it, the authors wrote. The reason was followed by a fear of addiction or dependence and the inability to pay. Some patients also reported using alternative therapies for pain relief, including physical therapy, massage and acupuncture.

Analgesic use was significantly less in patients with greater education levels (11 vs. 36 percent), with a trend toward lower use by whites (16 vs. 32 percent) and women (17 vs. 29 percent), the researchers found. The reasons for not taking analgesics included healthcare provider not recommending medication (87 percent), fear of addiction or dependence (79 percent) and inability to pay (79 percent).

Simone and colleagues recommended that “providers should have open discussions with their patients regarding pain symptoms and treatment.”

“To eliminate barriers to optimal pain management for cancer patients, healthcare providers should talk with their patients about pain symptoms and pain medications,” said Simone, a resident at the National Cancer Institute radiation oncology branch. “At our institution we have taken these steps by transitioning to an electronic medical record system that has been designed to require an evaluation and documentation of patient pain levels and pain medication responses by healthcare providers at each patient encounter.”